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NURS 5461 ANXIETY EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS GRADED A++
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NURS 5461 ANXIETY EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS GRADED A++ ANXIETY DISORDERS Excessive—overestimate the danger • Persistent, most develop in childhood—need to assess and treat in childhood • More in females than males [2:1] • Need to ask or they may not report WH...

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  • November 2, 2024
  • 19
  • 2024/2025
  • Exam (elaborations)
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NURS 5461 ANXIETY EXAM QUESTIONS AND ANSWERS

WITH COMPLETE SOLUTIONS GRADED A++


ANXIETY DISORDERS

Excessive—overestimate the danger • Persistent, most develop in childhood—need to

assess and treat in childhood • More in females than males [2:1] • Need to ask or they

may not report

WHAT ARE THE ANXIETY DISORDERS?

• Anxiety—Separation Anxiety; Panic Disorder, Agoraphobia, Social Anxiety Disorder,

Generalized Anxiety Disorder [GAD] • OCD and Related Disorders— OCD,

Trichotillomania, Hoarding, Excoriation Disorder • Trauma Disorders—PTSD, ASD,

Adjustment Disorder • They are the most common psychiatric disorders across the

lifespan

GERIATRIC LATE LIFE ANXIETY DISORDERS

• Difficult to diagnose due to somatic symptoms and multiple medical issues • 2x more

prevalent than dementia; 4-8x more prevalent than MDD • GAD in 50%, 30% will have a

specific phobia (e.g. agoraphobia), 10% will have OCD, PD, or PTSD • Cognitive—

hypervigilance to threat, seeing oneself as vulnerable, and perceiving demands of life

greater than resources, impact QOL, morbidity/mortality-*must avoid benzos

frailty puts them at risk, also recent loss contribtes to anxiety risk

NEUROBIOLOGICAL BASIS OF ANXIETY

,• Frontal Lobes • Higher psychological processes • Planning, decision making, impulse

control, language, memory, and others. • Neuronal circuitry in the frontal lobes is

shaped and fine tuned during adolescence • Experience plays a prominent role in these

changes.

AMYGDALA

• Role in emotional aspects of memory • Stored if highly emotional consequences •

Volume may vary based on genetics, traumatic experiences, disorders • Enlarged

amygdala volume & anxiety using MRI

depressed person smaller amygdala

*M w autism have fewer memory cells in amygdala

HIPPOCAMPUS

• Essential to the formation of memory • Smaller hippocampal volume in anxiety

disorders • Smaller hippocampal volumes in pts with sexual abuse.

depressed B hippoc. volume reduction

AMYGDALA AND STRESS—THE ANXIETY AND FEAR CIRCUITRY

Stress (traumatic event)→ senses → thalamus, where the stress is triaged → prefrontal

cortex to assess the level of danger (slow process) → amygdala • Prefrontal cortex

supposed to help process (impairment may be genetic) -->straight to amygdala• Severe

trauma/stress leads to un erasable fear response • Wired based on genetics (e.g. panic

disorder)

AMYGDALA & TRAUMA

Thalamus →Amygdala & Hippocampus • Emotional valence to the experience causing

motor responses & reflexes (startle, facial expression) • Hypothalamus then causes

, neuroendocrine & autonomic responses (CRH released) • Overactive amygdala →

hyperarousal symptoms • Startle, Irritability, Angry outbursts, Rage, Hypervigilance

→reexperiencing symptoms

low cortisol=inc. risk for PTDS

CORTISOL & KINDLING—BRAIN SENSITIZATION TO STRESS

• Cortisol is our primary stress hormone • Exposure over time to high cortisol ↑

sensitivity of thalamus to stimuli of psychologically threatening nature • This is kindling! •

Stronger response to lower levels of stimuli • ↑ cortisol reactivity • Highly reactive to

environmental stimuli • Intrusive memories of trauma from cortisol effects in forming

neural networks of memory

PTSD

GLUTAMATE AND THE ADRENAL GLAND—HAVE MAJOR ROLES

Can cause secretion by the hippocampus and prefrontal cortex during the stress [or

trauma] • Creates strong & vivid memories by prolonging excitation of cells as it

solidifies the trauma memories-->Recurrent dreams & Intrusive thoughts • Causes

excitotoxicity from oxidative stress & cell destruction-->Avoidance and numbing

symptoms • Amnesia from dissociation

NOREPINEPHRINE—FIGHT OR FLIGHT

• High levels of norepinephrine in PTSD and Panic Disorder • The Amygdala cues the

locus ceruleus of brainstem to ↑ firing of norepinephrine • Sensitization from repeated

activation • Not able to inhibit or modulate firing • Activates response much easier to

minor stimuli • Hyperarousal—anxiety, startle, irritability, sleep problems, nightmares • ↑

strength of trauma memories—flashbacks, distressing dreams, intrusive memories

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